I understand that most Swiss health care consumers must pay for their treatment up front, but the fact that they’re reimbursed for most of these expenses later makes their awareness of health care costs incomplete and largely academic. The larger the subsidy, the greater the demand for and overuse of provided services, leading to the escalating budget shortfalls that the Swiss system has seen.

People enjoy consumption without payment. This is not surprising, and it’s a lesson worth remembering. It’s not worth emulating.

look harder

Rationing of some kind is the only answer I see. It may have to be done by the government, and their track record is not so good. Rationing of post offices was floated/rejected and the elected officials got up in arms, and they might have been voted out if they didn’t.

The Swiss health care system [gated, but with abstract] has attracted interest from many conservatives because insurance there is mainly private, long-term, and personal and portable. By some estimates it also is the most egalitarian health system in the world. What is less well understood is that when the Swiss replaced mixed government and private financing of health care with mandatory health insurance in 1994, the resultant cost cutting efforts both damaged quality and introduced a lot of waste into the Swiss system.

In 2002, the government banned all new medical practices to control costs. The ban runs until 2010. Until then, a new physician cannot open a practice unless an old physician retires or dies. Efforts to save money by merging hospitals have created irrational allocations of specialty units. Alphonse Crespo, a Swiss orthopedic surgeon, reports that resources are now so poorly distributed that “because of the mergers, the distances between specialty units in some cantons are large.” Patients needing a urologist may have to go to another hospital. Patients have actually been put in helicopters just for a consultation. Researchers at the University of Lausanne report difficulties in accessing psychiatric care, rehabilitation care, long-term care, and orthopedic care.

Rationing is more likely to be imposed on the elderly and those with “a poor level of social integration.” Researchers in Geneva report that outcomes from the Swiss reforms suggest that financing health care using social health insurance is more regressive than direct financing. If true, this means that social insurance systems like ObamaCare end up taxing the poor more heavily [gated, but with abstract] than existing systems in which most people pay for their own care and the poor rely on government programs.

Between 1971 and 2005, the average inflation-adjusted general practitioner salary in Switzerland fell by 37 percent before taxes. More young doctors are choosing to become specialists because the pay is better and the work is more interesting. There is a developing shortage of primary care. In March, swissinfo.ch reported that general practitioners held the first doctors’ strike “in living memory.” The government had decided to further ration practitioner access to laboratory tests.

With mandatory health insurance premiums set to rise 15 percent this year, the Swiss government is proposing more cuts. The cuts include restrictions on the type of health insurance that can be offered, restrictions on outpatient services, and a “patient tax” that would require people to pay for their first six visits to a doctor’s office. To make care more difficult to access, Swiss insurers may also be required to offer free telephone medical services as a “first port of call.” Even with the cuts, in some cantons, the mandatory premium increase may be as much as 20 percent.